Sleep apnea’s effect on the eyes

Sleep apnea, a disorder that involves an involuntary cessation of breathing while someone is asleep, can have serious and life-threatening consequences if left untreated. But sleep apnea and a common treatment option—the use of a continuous position airway pressure (CPAP) machine—can have negative effects on eye health.

"The mainstay of treatment for these symptoms has to be protecting the ocular surface."

More than 18 million Americans have sleep apnea, according to the National Sleep Foundation, and risk factors include obesity, smoking, alcohol use, age (40 and older) and ethnicity (African Americans, Pacific-Islander and Hispanics). Sleep apnea causes fragmented sleep and low blood oxygen levels, which may lead to hypertension, heart disease and mood and memory problems.

Russell Beach, O.D., who practices in Virginia, notes that ocular health issues—including floppy eyelid syndrome and normal-tension glaucoma—may be common in sleep apnea patients. Floppy eyelid syndrome can lead to eyelids that don't provide effective protection for the eyes during sleep, which can cause dryness, severe ocular surface disease and even corneal abrasions. Glaucoma is also often linked to sleep apnea because the disorder affects the amount of oxygen being transported to end organs; when oxygen concentration to the optic nerve is reduced, the nerve becomes susceptible to damage.

CPAP machines—often an effective treatment option for sleep apnea—also can have an effect on a person's eyes.

"While many of these machines have water compartments that aim to avoid the emission of dry air, there is still considerable leakage or emission of air from the vents and sides of these devices. This air can move past the eyes, almost assuredly leading to increased ocular surface dryness and associated symptoms during the daytime," says Dr. Beach.

Depending on the severity of the apnea events, the condition can be life threatening and the CPAP machine greatly reduces those risks, so it should not be discontinued due to ocular irritation.

"The mainstay of treatment for these symptoms has to be protecting the ocular surface. The most efficient way to do this is to instill thicker artificial tears just prior to bedtime. Gels and ointment artificial tears should be considered. Any thinner or less viscous teardrop will not make much difference," says Dr. Beach.

"Depending on the severity of ocular symptoms, daytime treatment also may be indicated and normal dry eye therapies should be instituted at the discretion of the optometrist," he adds.

Dr. Beach is in a unique position to discuss the effects of sleep apnea on eye health, because he has sleep apnea himself.

"I think my experience with sleep apnea has made me especially tuned into patient symptoms of the condition. It's also given me a more personal approach to discussing the condition, the ocular associations with sleep apnea, and the importance of monitoring and treating the underlying condition as well as the ocular manifestations," says Dr. Beach.